Provider Demographics
NPI:1669578720
Name:WESTERN CAROLINA ORAL & MAXILLOFACIAL SURGERY, PA
Entity type:Organization
Organization Name:WESTERN CAROLINA ORAL & MAXILLOFACIAL SURGERY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:SOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-229-5733
Mailing Address - Street 1:112 LINER DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-2310
Mailing Address - Country:US
Mailing Address - Phone:864-229-5733
Mailing Address - Fax:864-229-0670
Practice Address - Street 1:112 LINER DR
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-2310
Practice Address - Country:US
Practice Address - Phone:864-229-5733
Practice Address - Fax:864-229-0670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty